Parkinson's HelpLine

From All Angles, PD is a Balancing Act

By Lee Dibble, P.T., Ph.D.

“There is more to falls in Parkinson’s disease (PD) than simply stumbling over an obstacle,” says Lee Dibble, P.T., Ph.D., associate professor at the University of Utah and Director of its Parkinsonism Exercise Program. “PD affects movement and a person’s ability to interpret sensations critical for balance. These combined effects make people with the disease much more likely to fall.”

Much of the research of Dr. Dibble has been in response to two important questions that face people who live with Parkinson’s. One is, “Who is at highest risk for falls, and how can falls — and injuries — be prevented?” And the other: “Does exercise improve balance for people with PD?” Dr. Dibble is looking at these questions from the many angles they require, taking a comprehensive approach to preventing falls in Parkinson’s disease. PDF, using its own multi-pronged approach to research, has supported several of his projects.

He began his studies as a graduate student, studying why people who live with PD seem to make smaller movements than those who do not — for example, shuffling their feet when beginning to walk, rather than taking normal steps. His project examined how sound and touch cues can help people with PD make larger movements and maintain their balance as they begin walking.

This early interest led to a much larger study, funded collaboratively by PDF and the Davis Phinney Foundation, to better understand the progression of the movement difficulties in Parkinson’s that most seriously affect quality of life, such as walking ability and balance. In this ongoing study, Dr. Dibble and colleagues at four academic medical centers are following 200 people with PD over two years. Their initial results are providing insights into the decline in walking and balance that people with Parkinson’s disease may experience in the absence of regular physical exercise.

In addition, their work has helped identify key barriers to exercise in people with PD. For example, their results suggest that although many people with PD know that exercise can ease PD symptoms, doctors must address issues such as fear of falling and lack of confidence in exercising in order to maximize participation in exercise.

With his expertise in balance and falls, Dr. Dibble is now mentoring others — including research assistant David Galaso, whose work was supported by a PDF Summer Student Fellowship in 2011. Mr. Galaso studied how a device worn on the ankle, an accelerometer, could be used to understand how people with PD lose their balance, and sometimes regain it, when they stumble.

Dr. Dibble also finds himself mentoring his peers, as a faculty member for a PDF-led online course designed for physical therapists. The course, which outlines how to evaluate, treat and deliver comprehensive care to people with PD, has already been utilized by thousands of physical therapists around the US.

And he is getting back to his intellectual roots by coordinating a special conference taking place in Sydney, Australia, this June. Funded by a PDF Conference Grant, the International Symposium on Postural Instability and Falls in PD will bring together a team of experts to strategize on future areas of research and identify best practices in helping people with PD avoid falls.

“Following people with Parkinson’s as their disease evolves highlights how profoundly the disease can affect their balance, and emphasizes the significant costs and consequences of poor balance and falls,” Dr. Dibble says. “In my mind, balance difficulties are among the most significant factors that affect the quality of life of people with PD as their disease progresses.” He concludes: “PDF has been generous in helping us to look at this critical issue from multiple angles.”